Cigna Advice Anyone? Really scared! So Confused!

[Carmen1963 27]

My Cigna policy is self insured -meaning the claims are paid by my husbands company and not by Cigna. Cigna is the administrator of the policy.

In my 70 (exaggerating) policy guidelines it states the following and does not refer to Cigna's bariatric guideline.

"Exclusions, Expenses Not Covered and General Limitations Exclusions and Expenses Not Covered Additional coverage limitations determined by plan or provider type are shown in the Schedule. Payment for the following is specifically excluded from this plan: for medical and surgical services intended primarily for the treatment or control of obesity. However, treatment of clinically severe obesity, as defined by the body mass index (BMI) classifications of the National Heart, Lung and Blood Institute guideline is covered if the services are demonstrated, through peer-reviewed medical literature and scientifically based guidelines, to be safe and effective for treatment of the condition."

I have a BMI of 46 and two comorbitities. I need some advice regarding the wording.

Does this mean as long as I have my PCP referral and my bariatric surgeons recommendation - that the 90 days are not required?

Just a peer to peer between my surgeon and Cigna? I've called Cigna twice to confirm that I don't have to do the 90 days....the rep I spoke to said there was nothing in my policy stating I had to.

THEN THE SURGEONS INSURANCE COORDINATOR CALLED ME - she says I have to do 90 days. ?????

I'm doing the NUT started it Monday and desperately trying to get the surgery done this year.

I also started Medifast last month with PCP. But I don't have documentation for it.

We've met all our deductibles and 20% co insurance.

My husband had a liver transplant earlier thus year -he had cancer. He's great now.

My biggest fear is that with Obamacare on the horizon that Cigna may change their policies or even worse my husbands company will change their policy in Jan. 2014. I'm really scared. I really need and want to get this done.

I've been caring for everyone else but myself for so long! Any words of advice would be greatly appreciated.

Regards - Carmen

[TerriBell 2]

Call the ins company. 90 days is going to go by whether you do ore-auth stuff or not. Every policy is different, so you need to speak with the ins company.

[Carmen1963 27]

I have spoken to them twice. I'm getting different answers than the insurance coordinator.

[Ms.Yvette 96]

I have spoken to them twice. I'm getting different answers than the insurance coordinator.

Has your insurance coordinator dealt with your insurance company with other patients? If so, then you should go by what she says wroth continued follow up with your insurance company. Sometimes the reps at my insurance company give out wrong information because they don't fully understand our because they are new. Good luck.

[CT203 4]

I. Also have cigna n i have to go thru 90 weight management nutric, i would like to get rhe surgery this year but they need a 90 days weight msg. Im thinking of actually calling tomorrow and speaking to someone like a manager or i may event call their headquarter. See if i can submit n hopefully get approve this year!

[azjanie 43]

I also have Cigna from a self-insured employer and do not have to complete a 90-day weight loss program but need 2 different letters of medical necessities. It all depends on what the company negotiated for in their coverage. I also have Cigna from a self-insured employer and do not have to complete a 90-day weight loss program but need 2 different letters of medical necessities. It all depends on what the company negotiated for in their coverage.

[Carmen1963 27]

Azjanie! That is great news....I am really happy for you. When is your surgery date?

How did you clarify what the employer negotiated? They HR?

[Jen35 283]

I have Cigna - not sure if it is self-insured though. I had to do the 90 days but it can vary depending on the coverage/contract by employer. I would go by what your insurance tells you on the phone and ask for the specific requirements for bariatric surgery. I did that and the insurance rep told me it was covered, gave me the info while the insurance coordinator at the dr. office told me the insurance said they DIDN'T cover it. I told her what the insurance rep said and she re-verified. You never know - I always take things into my own hands. I did the 90 days and then it took another 90 days for Cigna to approve it. And that was with me calling weekly to the nurse coordinator bugging her. I hope you can get in done by the end of the year. Fingers crossed!

[Carmen1963 27]

Thanks for calming me down ladies.....dealing with insurance is something! With my husbands transplant it was so easy compared to this!

[azjanie 43]

My insurance coordinator provided me a copy of my district's (I am teacher) insurance procedures for bariatric surgery, I then confirmed this information with my benefits department because I had a hard time believing that I wasn't required to participate in a 90 weight management program and when I called Cigna I keep getting different answers. So you might want to check with your husband's benefits department.

I am still waiting for my PCP to get the paperwork to the surgeon but hopefully will get everything approved soon.

[kvdme 64]

Cigna is pretty much the same all around

1. 90 days weight loss .. I was not required to loose wt, in fact I gained some, just have my food and wt and exercise monitored. so thats 4 doctor visits over 4 months.... and they have to keep close notes on your food, exercise and wt. Its in the details. Must be detailed. Some times your surgeon can recommend a good doctor for this part. Sometimes the PCP arent too familjar with the requirements

2. BMI min of 40 or 35 with 2 co morbid

and most important...

3. Your PCP statement must say

He gives clearance and you are recommended for surgery. It took me I don't know how many tries to get my PCP to get it right.

If you have any heart conditions, they will sometimes make you get clearance from them. I just needed a EKG at the hospital, I have Afib.

4. Meeting with dietician. Needs recommendation from them also

5. Psyc exam. to make sure you are able to handle whats coming. My surgeons office also recommended someone. Again, went to another one and he was clueless as to what was needed.

6. Surgeons recommendation and approval.

Don't be afraid to ask the surgeon staff about referrals or recommendations.. Its so much quicker!!

Good luck to you. Don't be like me and think your doing everything and have to start over. I started in Jan with my PCP, Had to start over in April. Approved. Sept 6th. Sleeved 30th.

[tryingforever 5]

Am going thru the 90 days now (Cigna) and my PCP let me author the letter so more details were added than he would have included. My 90 days are Aug, Sept & Oct. I hope to submit all of my stuff to Cigna the first week in Nov. Hope to get approval by end of Nov. and my surgery in Dec. my BMI is 37 & one co-morbid (Cigna said I only needed one). Do any of you who have more experience than me think this time frame is unrealistic?

[Slimleo74 5]

Am going thru the 90 days now (Cigna) and my PCP let me author the letter so more details were added than he would have included. My 90 days are Aug, Sept & Oct. I hope to submit all of my stuff to Cigna the first week in Nov. Hope to get approval by end of Nov. and my surgery in Dec. my BMI is 37 & one co-morbid (Cigna said I only needed one). Do any of you who have more experience than me think this time frame is unrealistic?

I had to do 4 PCP appts...July, Aug, Sept & Oct...I have Cigna! They said July-Aug 30days...Aug-Sept 60 days, Sept to Oct 90days....so U will probably need another appt. So acutally its 4 months;( But everything else is done..i went to a nutritional assessment & had a psych assessment...eveything got submitted to insurance this week & i'm waiting to hear some in 2 weeks from insurance!!

[Slimleo74 5]

Cigna is pretty much the same all around

1. 90 days weight loss .. I was not required to loose wt, in fact I gained some, just have my food and wt and exercise monitored. so thats 4 doctor visits over 4 months.... and they have to keep close notes on your food, exercise and wt. Its in the details. Must be detailed. Some times your surgeon can recommend a good doctor for this part. Sometimes the PCP arent too familjar with the requirements

2. BMI min of 40 or 35 with 2 co morbid

and most important...

3. Your PCP statement must say

He gives clearance and you are recommended for surgery. It took me I don't know how many tries to get my PCP to get it right.

If you have any heart conditions, they will sometimes make you get clearance from them. I just needed a EKG at the hospital, I have Afib.

4. Meeting with dietician. Needs recommendation from them also

5. Psyc exam. to make sure you are able to handle whats coming. My surgeons office also recommended someone. Again, went to another one and he was clueless as to what was needed.

6. Surgeons recommendation and approval.

Don't be afraid to ask the surgeon staff about referrals or recommendations.. Its so much quicker!!

Good luck to you. Don't be like me and think your doing everything and have to start over. I started in Jan with my PCP, Had to start over in April. Approved. Sept 6th. Sleeved 30th.

Wow...How U been doing with your weight loss?

[kvdme 64]

Pretty good! Glad I am on regular foods and feel pretty normal again. Clothes are starting to loosen up. Ive lost 24 lbs so far but I can feel a difference in my activity level, can tie my shoes without a moan, fit in airline seat. its great to feel those things again. 24lbs isn't much but hey its more than I could alone without this.

I had 80/20 insurance. Just got hit with bill from Anesthesiologist. That was an extra 700 bucks, hospital was additional 500... just waiting on the doctor bill...ugh so Im already up to 2300 out of pocket. first 1300 didn't count because its the doctors scam portion of all this. The little extras my doc and may others throw in that they make you give to pay for their staff. Like doctors "deposits"... Im filing a claim with my insurance for that anyway. Will see how that goes lol.

Good luck on your approval. They were most critical of the 90 day diet, yes its actually 120 days because first appt doesn't count. And the appts have to be more than 30 days from each other or they don't count either.